Inspection on 23/08/05 for Buckland Court

This inspection was carried out on 23rd August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Buckland Court 05/11/08

Buckland Court 15/11/06

Buckland Court 15/02/06

Buckland Court 21/02/05

Buckland Court 04/11/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Buckland Court Southmill Road Amesbury Salisbury Wiltshire, SP4 7HR Lead Inspector Sally Walker Unannounced 23 August 2005 rd The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Buckland Court Address Southmill Road Amesbury Wiltshire SP4 7HR 01980 623506 01980 626638 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Orders of St John Care Trust Mrs Diane Bowden Mrs Julie Watts Care Home 50 Category(ies) of DE(E) Dementia - over 65 (18) registration, with number OP Old Age (50) of places Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users who may be acommodated in the home at any one time is 50. 2. No more than 18 service users aged 65 years and over with dementia may be accommodated in the home at any one time. Date of last inspection 21st February 2005 Brief Description of the Service: Buckland Court is a single storey care home purpose built by the local authority nearly 30 years ago. It is registered to The Orders of St John Care Trust to provide care for a total of 50 older people, 18 of whom may have a dementia. All accommodation is in single rooms with wash hand basins, most rooms being somewhat smaller than standard. There is one room for respite care and a separate day care facility for up to 20 older people. The Orders of St John Care Trust were registered in 1999. The staffing rota provided for a care leader and 4 care staff during the morning, a care leader and 3 care staff during the afternoon and evening and 3 waking night staff. There were 3 housekeepers, a chef and a kitchen assistant. Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place between 9.25am and 4.10pm. Mrs Watts was on sick leave on the day of the inspection and feedback was given to her the following day. Rebecca Andrews assisted the inspector with access to the case files. Six residents and 4 staff were spoken with. What the service does well: What has improved since the last inspection? What they could do better: The home needs to have an understanding of the Conditions of Registration and ensure that no more than 18 residents are admitted with dementia. The home is not registered for Mental Disorder and must not admit residents in this Category. Staffing levels do not support residents to achieve everything that is detailed in their care plan or indeed other activities that they clearly wish to do, for example going out or having regular baths. The organisation’s staffing proposal of May 2005 has not as yet been put into place. There were a number of requirements about the safety and accessibility of the environment which had not been addressed for over a year due to Mrs Watts waiting for the organisation’s financial approval. Some residents who were Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 Page 6 deemed unsafe when going out of the building were not protected as they could access the fire doors and go out unnoticed. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 4 The home was not able to demonstrate how they were complying with their Conditions of Registration. Some residents’ experienced positive outcomes from their admission to the home. EVIDENCE: It was not easy to establish from the care plans or the room allocation wall planner which of the 18 places related to the registration category of dementia. From discussions with staff it was possible that the home may have admitted more than 18 people with dementia. It was also clear in talking to residents, staff and in consideration of care plans that people with mental disorder rather than dementia had either been admitted or the category of registration had not been considered when the home first applied to register. The home must carry out an assessment of residents to consider whether they are complying with the Conditions of Registration. The manager must inform the Commission of the outcome of that assessment and an application to vary the conditions of registration submitted immediately if required. One resident showed the inspector their service users guide. Another resident told the inspector that they liked the home and had settled in very well although they had not expected to at their time of admission. Another resident Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 Page 9 said that they felt their health and well being had improved significantly in the short time they had lived at the home and gave example of the progress. Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 & 10 Care planning was improved with some more detail needed. Residents’ healthcare needs were being met but this was not always supported by the records. Lack of risk assessment puts residents at risk of developing pressure sores. Residents were respected and their privacy of paramount importance. EVIDENCE: Each resident had a plan of care. Some care plans were very detailed with clear guidance on how residents should receive care. Records suggested some residents had mental disorder rather than dementia and the home must urgently consider their conditions of registration. Some identified needs were not clear, for example, to whom any weight loss should be reported or what should be done about it, reasons for blood samples and a mid stream urine sample was a direction for a person with dementia. Other care plans were more detailed with good detail of medical conditions being monitored. Some care plans gave a good picture of residents needs. Forms normally used for recording care needs had been removed from some of the files, including the long-term care plan and assessment form. Staff were instructed to remove the forms a few weeks after residents were newly admitted. Staff believed these forms contained much information about residents and did not understand the rationale for their removal. The inspector noted that staff paid Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 Page 11 attention to residents being well groomed with clean nails, glasses, hair and clothing. The requirement that each resident had a written pressure sores risk assessment and that Tissue Viability training must be sought from the Specialist Nurse had been achieved in part. Some staff received training that afternoon and another session was planned. The organisation’s pressure risk assessment form had been removed from files and not replaced with any other tool. Care plans identified what staff should do when wounds or redness were noted. However there was no evidence of how these risks were identified and eliminated. This is poor practice, potentially puts some residents at risk and shows a lack of understanding of the process of assessing tissue viability. Action must be taken long before any red marks or wounds appear. There was pressure-relieving equipment in place and the district nurses were involved once marks had occurred. There were some statements in the daily reports which were not clear, for example, “sore on back”, “couple of weeping wounds on right leg” and “skin flap on right leg”. Body maps were seen in some files and the inspector advised that they should be used to record all wounds noting size and exact position. One daily report stated that a resident urgently needed chiropody, then that the resident had refused; there was no record of what staff had done about this. Other files contained dates for chiropody appointments. It was clear from other records that any health concerns were promptly referred to the district nurse or GP. The requirement that risk assessments on bathing identified explicit times that residents can be left with out staff when choosing to bath alone had not been actioned. The requirement that a policy was in place for the giving of personal care by staff of a different gender and that residents were consulted about who should give their care and the outcomes recorded, had been actioned in part. The care plans showed residents preferences but there was no policy in place for the protection of the residents and in particular any male staff. Some residents said they did not mind care from male staff. It was noted during the inspection that staff were respectful of residents and any personal care was given behind closed doors. Most of the residents spoken with said the staff administered their medication although one resident had their own inhalers on them. Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 Residents followed their own routines and spend their day where they wish. Residents are encouraged to retain contact with family and friends. Residents were very satisfied with the range and variety of the meals provided. EVIDENCE: Residents follow their own routines and spend their day where they wish. One resident said they liked to be on their own and staff respected that. Some residents said that they got up in their own time, others said they were brought a cup of tea about half and hours before breakfast at 8.30am. One resident said they had been told they had to be in bed by 9.00pm. Mrs Watts later confirmed that the resident had been misinformed as this was not the case. Residents said there had been some organised trips out. Residents talked about bingo, quizzes and going out for a cream tea. Two residents spoke about the parties they were going to have for their birthdays at the beginning of the following month. One resident said they joined in with the activities provided by the separate day service. One resident said they could go and walk in the garden whenever they wanted. The requirement that a programme of specialist training was provided specific to the role of activities coordinator, with emphasis on the needs of residents with dementia and sensory impairment and should include all staff, had been Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 Page 13 actioned in part. Some training had taken place but there was no ongoing programme in place. The home’s minibus had been withdrawn due to age. Staff said it was not being replaced and arrangements now had to be made with another home in the organisation in Salisbury to loan their minibus to take residents on a trip. All of those residents spoken with made very positive comments on the quality and variety of the food provided. One resident said they missed making a cup of tea when they wanted and they did not know if there were any facilities. They also said a cooked breakfast was provided on a Saturday. Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Systems were in place for residents and visitors to make complaints about the service or report any allegations of abuse. EVIDENCE: The complaints procedure was displayed in the main entrance. Residents said they felt confident about bringing to staff’s attention anything they were not happy with. Copies of the local vulnerable adults procedure entitled “No Secrets in Swindon and Wiltshire” were available in the main entrance. Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 24 & 26 Residents were happy with their environment, particularly their own bedrooms. The home has been slow to action requirements to improve the quality and safety of the physical environment. EVIDENCE: Residents said they liked their bedrooms and some pointed out their own furniture. Two residents said they could not have a key to their rooms. This was discussed at the last inspection when it was agreed that residents could have keys. This should be brought up with residents again to confirm that they can have a key to lock their bedroom doors. Most of the bedrooms, except three had the name of the residents on the doors. These unnamed rooms were clearly occupied. Staff reported that a new hot water system had been installed. The new piping was in evidence around the building and it is expected that this will be boxed in to prevent any risk to residents particularly when the hot pipes are within reach, for example, in their bedrooms, bathrooms or communal areas. One resident said they had no hot water in their bathroom and a maintenance person who was working in another area said they would investigate. Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 Page 16 Mrs Watts later reported that new curtains had been ordered for each of the windows to the fire doors at the end of each wing. The requirement that one of the bathrooms that had been used for storage was made available for residents has now been outstanding for 3 inspections. At the last inspection the room had been cleaned and redecorated, but it was reported that it was still not used due to problems with water supply and lack of a hoist. In her action plan Mrs Watts reported that the matter had been referred to the organisation’s property agents. The bathroom is still not used. Staff reported that residents on that wing would be taken to a bathroom in another wing. The requirement that the hot water to the heated towel rail in one of the other bathrooms was either restored and the radiator guarded, or removed and replaced with a guaranteed low surface temperature radiator so that the room can be used by residents. This was identified in Mrs Watts’ action plan dated 26th January 2004 when it was referred to the property department and again in her action plan following the inspection of 21st February 2005. No action had been taken to address this matter. The requirement that damage to the residents bedroom doors and surrounds is repaired and that these areas are repainted had not been actioned following the last 2 inspections. In her action plans following these inspections Mrs Watts stated that the handyman was addressing the redecoration of these areas, and following this inspection she said that the work was being done the following week. One area which had benefited from refurbishment since the last inspection is the two servery areas in the dining room. Staff working in those areas said they were very pleased with the new units and upgrade of the area. It was much easier to clean and the storage was now enclosed. These areas are now decorated to the same standard as the dining room. The carpeting on the approach to the dining room from the lower side of the building was very discoloured and looked dirty. Staff assured the inspector that they tried very hard to keep the area looking clean; with weekly deep cleaning and even a contract cleaner. Mrs Watts said the carpet was only 18 months old and had been selected by a previous manager. During the inspection staff were trying to manage a resident who was not safe when exiting the building. This resident went out many times during the day. Staff said that their concerns had been referred to the Care Services Manager, responsible for the home and he was considering the installation of safety bolts which complied with fire regulations. Many of the residents made very positive comments about the quality of the laundry service prompted by items being delivered during discussions. The Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 Page 17 laundry was not inspected as the door was locked. The home was cleaned to a good standard and no unpleasant odours were detected at any time during the inspection. Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Current staffing levels do not allow residents to be supported as defined in the care plans. Residents cannot go out as much as they wish. Staff cannot achieve all of the administrative work that they are required to do with the current staffing levels. EVIDENCE: There were 4 care staff and a care leader on duty on the morning of the inspection. There were also 3 housekeepers, 1 chef and a kitchen assistant. The care leader was running the shift and dealing with visitors, the district nurses, giving medication, answering all telephone calls and dealing with a list of items identified in the diary. One member of care staff escorted a resident to a hospital appointment which meant that only 3 staff were in the building for one hour during the morning. Staff were also supporting the day service with cover for sick leave. There was an extra shift from 10.00am to 6.00pm to ease the staffing levels. Staff were also trying to manage a resident who was not safe when exiting the building. There were a number of times when this resident went from the building during the inspection. Staff were asked whether they were still coming in on their rest days to do paperwork and they replied that they were. They also said that there were some staff off sick and their shifts were being covered as overtime. The requirement that an urgent review was undertaken of the care staffing levels, based on the current dependency levels of residents had been actioned in part. The organisation had submitted a proposal to the Commission in May 2005 which showed an increase of 1 care staff between 7.30am until 3.00pm and proposed a new position of carer support with duties of providing meals and beverages, activities, cleaning residents rooms and bed making. However at this Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 Page 19 inspection it was noted that none of these proposals had been put into action. Current staffing levels would not support residents with the levels of care identified in the care plan, including personal care as well as any one to one activities which they may like to be involved in like going out. Some residents said that there were not enough staff and one of these said that staff never gave them the impression that they were a trouble. One resident said they had a keyworker but they did not know who it was. Another said they did not see much of the staff during the day. Another resident said that they had not had a bath for a time because the staff were too busy. One resident said that there had been a lot of new staff who they were still getting to know. Staff said that the new staff were in the process of being inducted. Care leaders were undertaking NVQ Level 3. Staff had recently undertaken training in infection control, moving and handling and food hygiene. Residents said that staff were very friendly and always knocked on their doors before being invited to enter. Many residents talked of the good relationships they had with their keyworkers. Those staff who were on duty during the inspection were seen to work professionally and in a friendly manner with residents. Although the care leaders were very busy they were seen to manage the shift and delegate duties where necessary. Discussion with staff showed their positive commitment to the residents and their work. Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 The home aims to operate with the best interest of the residents but the staffing levels do not always support this. Many administrative duties are suffering as staff try to balance the demands of the work. EVIDENCE: Mrs Watts was unavailable during the inspection and the findings of the inspection were reported to her the following day. Much of the action required to address the findings of the inspection is awaiting financial approval from the organisation. Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 x 2 x x 3 x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x x x x x Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP 8 Regulation 13(4)(c) Requirement The person registered must ensure that each resident has a written assessment with regard to their risk of developoing pressure sores. (this part of the requirement not actioned) Training and advice must be sought regarding Tissue Viability. The person registered must ensure that the bathroom identified is not used for storage and is available for the residents use. (Not actioned at 23rd August 2005). The person registered must ensure that the hot water heated towel rail in one of the bathrooms is either restored and the radiator guarded or removed and replaced with a guaranteed low surface temperature radiator. (Not actioned at 23rd August 2005). The person registered must identify in risk assessments and care plans explicit times that residents can be left without staff when choosing to bath alone. (Not actioned at 23rd August 2005). The person registered must Timescale for action 30th September 2005 2. OP 21 23(2)(j) 31st October 2005 3. OP 25 13(4)(a) 31st October 2005 4. OP 28 13(4)(b)& (c) 30th September 2005 5. OP 4 12 & 14 23rd August Page 23 Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 6. OP 27 7. OP 37 8. OP 19 9. OP 19 ensure that the Conditions of Registration are complied with; the number of residents in each Category and the Category of Registration. [Care Standards Act 2000 Order 2001, Schedule 2 paragraph 1(b), see also Certificate of Registration]. There must be a review of all the residents individual diagnosis and an application to Vary the Category of Registration submitted if required. 18(1)(a) The person registered must ensure that staffing levels are sufficient to meet the needs of residents as defined in the organisations own staffing proposal dated 24th May 2005. 17 The person registered must ensure that if useful recording systems are removed from files, that they are replaced by a more suitable system or a rationale is given for their removal. 16(2)(c) & The person registered must 23(2)(d) submit an action plan with timescales for the replacement of the stained carpet in the corridor near the dining room. 13(4)(a), The person registered must (b)&(c) ensure the safety of those residents who are deemed not able to exit the home unsupervised. This may include specialist adaptations to the fire exit doors in consultaion with the Fire Authority. 2005 23rd August 2005 23rd August 2005 30th September 2005 30th September 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Version 1.40 Page 24 Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc 1. 2. OP 7 OP 37 The person registered should consider the use of body maps to augment the recording of wounds. The person registered should consider reviewing the daily reporting to ensure that statements are clear and detailed. Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 Page 25 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Buckland Court D51_D01_S28269_BucklandCourt_V240344_230805_Stage4.doc Version 1.40 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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